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Median nerve versus flexor tendons: visualization of median nerve level changes in the proximal carpal tunnel during wrist movement with dynamic high-resolution ultrasound

Suren Armeni Jengojan
Suren Armeni Jengojan
, 
Lisa Lechner
Lisa Lechner
, 
Gregor Kasprian
Gregor Kasprian
, 
Elena Drakonaki
Elena Drakonaki
, 
Veith Moser
Veith Moser
, 
Žiga Snoj
Žiga Snoj
 und 
Gerd Bodner
Gerd Bodner
   | 11. Sept. 2023
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Article Category: Research paper
Online veröffentlicht: 11. Sept. 2023
Seitenbereich: e114 - e121
Eingereicht: 25. März 2023
Akzeptiert: 20. Juni 2023
DOI: https://doi.org/10.15557/jou.2023.0020
Schlüsselwörter
© 2023 Suren Armeni Jengojan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Examination scheme: wrist alignments
Examination scheme: wrist alignments

Fig. 2.

Wrist in maximum flexion: no level change of MN (pattern A). MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Wrist in maximum flexion: no level change of MN (pattern A). MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone

Fig. 3.

Wrist in maximum flexion: partial or mild gliding of MN parts (<1/3) onto the tendon level (pattern B). MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Wrist in maximum flexion: partial or mild gliding of MN parts (<1/3) onto the tendon level (pattern B). MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone

Fig. 4.

Wrist in maximum flexion: significant or total gliding (>2/3) of the MN cross-section onto the tendon level (pattern C). MN – median nerve; FT –flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Wrist in maximum flexion: significant or total gliding (>2/3) of the MN cross-section onto the tendon level (pattern C). MN – median nerve; FT –flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone

Fig. 5.

Wrist in maximum flexion: gliding of the MN below the flexor tendons (pattern D). MN – median nerve; FT -flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone
Wrist in maximum flexion: gliding of the MN below the flexor tendons (pattern D). MN – median nerve; FT -flexor tendons; TCL – transverse carpal ligament; SB – scaphoid bone; PB – pisiform bone

Fig. 6.

Median nerve: measurement of vertical displacement. A. neutral wrist position; B. maximum flexion
Median nerve: measurement of vertical displacement. A. neutral wrist position; B. maximum flexion

Fig. 7.

Median nerve: gliding patterns during movement from neutral wrist position to maximum flexion in individual subjects (n = 32)
Median nerve: gliding patterns during movement from neutral wrist position to maximum flexion in individual subjects (n = 32)

Fig. 8.

Median nerve: presence of level change in individual subjects (n = 32)
Median nerve: presence of level change in individual subjects (n = 32)

Fig. 9.

Wrist in maximum flexion: MN in CTS patient. MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament. Note for comparability: an 18 MHz linear transducer was used here, whereas a 15 MHz linear transducer was used in the other cases
Wrist in maximum flexion: MN in CTS patient. MN – median nerve; FT – flexor tendons; TCL – transverse carpal ligament. Note for comparability: an 18 MHz linear transducer was used here, whereas a 15 MHz linear transducer was used in the other cases

Gliding patterns in active and passive wrist flexion of both hands cumulatively (n = 64)

Wrist movement Pattern A Pattern B Pattern C Pattern D
Active flexion 12/64 8 men / 4 women 7/64 2 men / 5 women 39/64 21 men / 18 women 6/64 1 man / 5 women
Passive flexion 55/64 29 men / 26 women 1/64 1 man / 0 women 5/64 1 man / 4 women 3/64 1 man / 2 women

Distribution of gliding patterns in passive wrist flexion between the right and left hands in 32 individuals (n = 32)

Left/Right Pattern A Pattern B Pattern C Pattern D
Pattern A 26/32 14 men / 12 women 1/32 1 man / 0 women 1/32 0 men / 1 woman 0
Pattern B 0 0 0 0
Pattern C 1/32 0 men / 1 woman 0 1/32 0 men / 1 woman 0
Pattern D 0 0 1/32 1 man / 0 women 1/32 0 men / 1 woman

Baseline characteristics

Age  
Median (IQR) 23 (IQR = 22–26)
Minimum 20
Maximum 30
Male (median, IQR) 25 (IQR = 22–26)
Female (median, IQR) 23 (IQR = 22–25)
Gender  
Male (n,%) 16 (50%)
Female (n, %) 16 (50%)
Handedness  
Right (n, %) 30 (94%)
Left (n, %) 2 (6%)

Distribution of gliding patterns in active wrist flexion between the right and left hands in 32 individuals (n = 32)

Left/Right Pattern A Pattern B Pattern C Pattern D
Pattern A 4/32 3 men / 1 woman 1/32 0 men / 1 woman 2/32 2 men / 0 women 0
Pattern B 1/32 0 men / 1 woman 0 3/32 0 men / 3 women 0
Pattern C 0 2/32 2 men / 0 women 15/32 8 men / 7 women 1/32 0 men / 1 woman
Pattern D 0 0 1/32 1 man / 0 women 2/32 0 men / 2 women
eISSN:
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Sprache:
Englisch
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